The straight dope on Italian health and medical care, from an American woman doctor who lives and works in Rome. Her memoir, Dottoressa, will be published in May 2019.

Tuesday, March 13, 2018

Mario and Nikolas

Recently I’ve been thinking a lot about a patient I’ll call Mario.
He was a ministerial employee, happily married, and totally nuts. Under his
façade of normality lay a vast web of paranoid delusions that linked his
family, the Church, and both Cold War antagonists in a delicate equilibrium. All
through the 1980s I prescribed antipsychotic medication under supervision, and he
did just fine. But when the Berlin Wall fell in 1989 the web no longer held, the
balance wobbled, the web fell apart, and Mario snapped. He first confessed
vague violent fantasies, then disappeared from treatment, only to resurface in
prison, after stabbing his cousin.

What reminded me of Mario in these last weeks was the rather
similar story of Nikolas Cruz, the Parkland, Florida mass murderer. Both were
deeply disturbed, both were armed, both were obsessed with fantasies of violence,
and in both cases outside events – in Cruz’s case the death of his mother, in
Mario’s the end of the Soviet empire – cut whatever inner restraints had
prevented acting on those fantasies. What made the difference between one man wounded
and 17 teenagers dead was the weapon: Cruz carried an AR-15, Mario a kitchen
knife.

Nikolas walked into a
Florida gun store, passed the laughable instant background checks, and walked
out with his gun. In
Italy you can’t buy a pistol, or carry any firearm on the street, without a
license (porto d’armi) issued by the
police.What you need to get that license:

1) A specifically authorized specialist
physician (not me, and not your own General Practitioner) must certify your
mental health. So much for Mario or Nikolas.

2) A specifically authorized physician
must certify that you have no visual, hearing, or other physical problems that
would interfere with proper use of a firearm.

3) You must have a clean criminal
record, with no history of violent crimes or restraining orders.

4) You must not be an army deserter or
a conscientious objector.

5) You must have had proper training
in gun use and safety, either in the army or a certified two-month civilian
course.

6) You must provide a list of all the
people you live with.

7) You must demonstrate a specific
reason for being at high risk of violent attacks – owning a jewelry shop or working
as a security guard will do. Few people meet the test, and certainly not Mario
or Nikolas.

You have to reapply for your carry license every year, and you
can only own 200 bullets at a time.

If you only want a weapon firearm for sport* or hunting the process is
easier – you can buy a few shotguns on the basis of just criteria one through
six, with a license good for six years. But by law you have to report every acquisition
of a weapon or ammunition to the police within three days. You must also store your
guns in such a way that children, thieves, and household members who are mentally
ill, alcoholics, or drug addicts can’t get hold of them; and transport them to
and from the shooting range or game reserve unloaded and locked away. If a
family member goes to the police about fights at home, the cops will come take
away your guns.

Moral of the story: there are one tenth as many guns in Italy per
capita as in the US. And one
tenth as many gun deaths, even if you include suicides, accidents, and the
Mafia.
*A reader has pointed out that air guns used for target practice can be purchased without a license.

Thank you for this piece, Susan. The general American thinking about firearm possesion is bonkers. Even many progressives don't go beyond background checks or eliminating semi-automatic weapons; clearly insufficient. The story and statistics you present most clearly illustrate that.

Great point. Not long ago I mentioned to an American friend what seemed to me the obvious need for a registry of guns and of gun owners, similar to what exists for that other potentially deadly technology: motor vehicles. I was shocked to hear from him that this idea was so far from what would be acceptable in the US that expressing it would label me as a dangerous fanatic.

Such a "sane" analysis of levels of insanity which should have absolutely no links to guns. Mario, though a heartbreaking story, is luckier than his American counterpart. This should shame the NRA! Thank you for an intelligent and interesting read!

About Me

I moved to Rome in 1978 after finishing my training in New York, and have been practicing primary care internal medicine there ever since, treating a clientele that’s featured Roman auto mechanics and British ambassadors, Indonesian art restorers and Filipina maids, Russian poets and Ethiopian priests. When not seeing patients, doing research in psychosomatic medicine, or being the Artist's Wife to my composer husband, I've written a book about my medical adventures, Dottoressa: An American Doctor In Rome, to be published by Paul Dry Books in May 2019.